View all posts by Marsha Fowler
Book “Nursing Ethics, 1880s to the Present:
An Anthology of Lost Wisdom and Identity”

A nurse friend and colleague recently contacted me to tell me of an interaction she had with a colleague of hers.  My friend mentioned to her that she knew someone who had worked on the new revision (2025) of the ANA Code of Ethics for Nurses. Her colleague responded, “Oh, I thought it was written by AI.”

After I recovered from acute apoplexy, I decided to challenge Google’s Gemini AI to write a code of ethics for nurses (on July 6, 2025).  This is what came back:

Nursing code of ethics (AI generated)

The nursing profession is guided by a code of ethics that emphasizes the moral principles, standards, and values inherent in the practice of nursing. The American Nurses Association (ANA) developed and regularly updates the Code of Ethics for Nurses as a foundational guide for ethical decision-making and professional conduct.

Here are the key principles and provisions that are central to the nursing code of ethics

4 core ethical principles

1. Autonomy: Respecting the patient’s right to self-determination and their choices about their healthcare decisions, based on their beliefs and values.

2.Beneficence: Acting for the good and welfare of others, prioritizing the patient’s best interest, and guided by compassion.

3. Justice: Providing fair and equitable treatment to all patients, regardless of their background, beliefs, or circumstances.

4. Non-maleficence: Commitment to minimize harm and ensure patient safety by avoiding actions that could cause harm or negative side effects.

The AI rendered code of ethics for nursing goes on to repetitiously bookend the four principles, and includes a vapid summary of the provisions of the 2015 Code, not the current (Jan) 2025 Code:  

9 provisions [author’s note: there are now 10 provisions]

The ANA’s Code of Ethics also includes nine provisions that address various aspects of nursing practice and assert the ethical and moral foundation of the nursing profession. These provisions cover areas such as practicing with compassion and respect for each individual, prioritizing the patient as the primary commitment, advocating for and protecting patient rights and safety, taking responsibility for nursing practice and decisions, and maintaining personal health and integrity. The provisions also include establishing an ethical work environment, advancing the profession through research and policy, collaborating with others to promote health and reduce disparities, and advocating for social justice.

Purpose of the code

The Code of Ethics provides guidance for nurses to navigate ethical challenges, make informed decisions, and uphold the integrity of the profession. It acts as a moral compass for prioritizing patient care, maintaining confidentiality, advocating for patients, and promoting healthcare equity.

THIS IS AI GENERATED RUBBISH. The four principles AI alleges, are principles of bioethics, not nursing ethics, and they do not appear in the Code.  Beneficence and nonmaleficence are not mentioned.  The word autonomy appears twice, once as patient autonomy and once as respect for autonomy of the nurse.  The term justice appears several times as social justice and as an end to be sought.  None of these – beneficence, nonmaleficence, justice, [respect for] autonomy — appear as principles of ethics in the Code.  In fact, during the 1985 revision process for the ANA Code of Ethics for Nurses with Interpretive Statements (the Code), the revision committee attempted to incorporate these principles, and bioethics more broadly, and they did not fit, though a bit of a vocabulary of autonomy, confidentiality and privacy was shoehorned in.  They did not fit because of the very nature of nursing ethics, as relationally structured, and moral-character (virtue) based, and as grounded in the values of the nursing tradition and community.  The Code arises from the 150 year moral tradition of nursing, and its extensive literature, that greatly predates the emergence and existence of the field of bioethics. The nature of its structure and values is such that it preventively wards-off dilemmas and problems.  While principles are useful in situations of dilemmas or problems, and they are limited but helpful tools for that, they are not the substance of nursing ethics.

This literature is, of course, not material that even the best AI accesses.  AI does not reach back into the now out-of-print literature in nursing ethics, its 100 or so textbooks and editions (some of which are digitised).  It does not reference the early years of ethics articles in the AJN that are in the digitized data bases, neither does it reach into the reprinted and digitised speeches on ethics given at the ICN from the early 1899 forward, nor the minutes of the US, international, or foreign ethics committees established from the 1800s forward.  AI does not access minutes of nursing alumnae associations, commencement addresses, or nursing ethics literature that is not published by a major publishing house.

A bit more to the point, strong AI accesses a published, predominantly male literature.  I say this not because I have tallied all the journal articles by sex, but because historically women’s literature has not been preserved.  For example, when nursing moved from hospital schools to universities, the nurse-written textbooks on ethics were not accessioned by the university libraries, (perhaps with the exception of Isabel Robb’s book).  These textbooks became library discards in favor of those used by philosophy departments (that now taught ethics to nursing students), based largely upon UK and European ethics, or Roman Catholic theology in Catholic nursing schools. The nursing ethics textbooks were even discredited as ethics at all. The philosophy of Pragmatism, which informed nursing ethics from the late 1800s to the rise of bioethics, is not even mentioned, and the virtue theory that grounds nursing ethics is ignored. Apart from these nursing ethics textbooks, women’s literature has historically not been preserved, or accorded its due. It is possible, even with more men in nursing now, that nursing itself suffers the same degree of dismissal of its literature that has been the fate of women’s literature.  The bioethics literature, broadly, is largely reliant and focused upon medical, not nursing, literature; in any number of bioethics textbooks, nursing is not mentioned at all, and nursing books and articles rarely appear in the bibliographies.

Another issue lurks underneath.  AI is a guy. Globally, 82% of AI researchers are male.  It is important that we explore the subtle, or perhaps not so subtle, ways in which AI is gendered and may further patriarchy, and perhaps in bioethics, medical hegemony.

To return to the AI-generated code of ethics above, its vacuous, vapid, and inaccurate content reflects skimming and plucking from the assorted webpages of the internet, and no deeper dive into substantive literature.  Not all AI engines are the same and some are better and deeper than others, though they will all have the issues of discernment, gender, preferential literatures, and perhaps laziness when it comes to deeper sources.  Nursing authors and students beware!

It is important to remember that AI has never been a nurse. It has never double-shifted on a short-staffed unit, it has never been instructed to lie to or deceive a patient, it has never worked with an alcohol or drug-impaired physician, it has never dealt with an abusive or violent patient, it has never cared for an enemy combatant, it has never held the hand of a dying patient, it has never provided touch and a caring voice for a premature neonate in an isolette, it has never comforted the grief of a family that has lost a loved one, it has never helped the struggling parents of a child with severe mental illness, it has never fed an elderly person with dementia, it has never felt the cold sweat of an anxious hand, it has never smelled a diabetic breath or an infection, it has never known new-baby smell;  it has never…been a nurse.  It can of course dredge the literature where it will see a superfluity of articles on moral distress, “dilemmas” and “problems,” but there is well more to nursing than that.  AI will not see or account for much of the core nursing, its values such as compassion, dignity, kindness, respect, knowledge, skill, wisdom, and more…and AI has no experience of these moral values as both cherished and normative within the community and tradition of nursing.

Bibliography

American Nurses Association. The Code of Ethics for Nurses. Silver Spring, MD. 2025.

Fowler, Marsha. Nursing Ethics, from the 1800s to the Present: An Archeology of Lost Wisdom and Identity. London: Routledge, 2024.